ZENFULdog Training Client Intake Form

ZENFULdog Training Client Intake Form

Please email us at info@zenfuldogtraining.com to reserve an appointment
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number

Area CodePhone Number
Dog's Name:
Breed:
Sex:
Age:
Spay/Neutered:
Other People in Household:
Occupation/Time spent outside home:
Does your dog have up to date core vaccines and bordetella?
Veterinarian/veterinary clinic
Medical Problems/medication(s)/allergies
brand of food and how many times a day?
eat right away/finish meals?
Other treats/snacks (Kong/puzzles) and how Often?
Where was dog obtained and how long ago?
housebroken/potty trained?
crate trained?
where does dog sleep? in what room?
Left in yard/outside alone (fenced/tied/stimulation collar)?
Where is he/she kept when pet-parent is away (crate/whole house/room/outside)?
Any previous training for your dog? Methods used?
What is your previous training? (Taken obediences classes, private classes, studying to become a certified trainer, or other) Methods used?
How often is your dog exercised? What kind (leash walks, games, fetch, nosework)?
If you are interested in private or group programs in Canisports and leading a fun and healthy canine lifestyle, please indicate all that apply

CanihikeCanicrossBikejorePaddle board/kayakKicksledTricksParkourFitnessCold Laser Therapy Treatment
If you interest in private or group programs for teaching your dog skills to navigate the world confidently while building and enjoying a unique relationship with your dog. Please check all that apply

Decompression walksWatch the world go by and calming protocolsLoose Leash Walking for on leash socialization and explorationEnviromental management and setting your dog up for successPositive reinforcement, games and relationship buildingFun Recall Training SafelyPuppy Socialization Class (under 6 months)Dog/Adolescent Socialization Class ( 6 months and older)
If your dog has a behavioural concern, what is the main issue you are concerned about? Please check all that apply

Aggression toward unfamiliar dogsAggression toward another dog or pet in the homeAggression toward an unfamiliar person on walksGuarding food/toys/bones/personAggression toward family memberAggression toward visitorsAggression when being handled/picked up/given medsAggression toward veterinarian/groomer/pet sitter/dogwalker
If your dog has threatened or bitten another dog, please check all that apply.

Growls, lunges, and/or barks at another dog in homeGrowls, lunges, and/or barks at other dogs on walksBit Another dog while on leashBit another dog off leashLevel 1. Obnoxious or aggressive behavior but no skin-contact by teeth, air snapped.Level 2. Skin-contact by teeth but no skin-puncture. However, may be skin nicks (less than one tenth of an inch deep) and slightbleeding caused by forward or lateral movement of teeth against skin, but no vertical punctures.Level 3. One to four punctures from a single bite with no puncture deeper than half the length of the dog’s canine teeth. Maybelacerations in a single direction, caused by victim pulling hand away, owner pulling dog away, or gravity (little dog jumps, bites anddrops to floor).Level 4. One to four punctures from a single bite with at least one puncture deeper than half the length of the dog’s canine teeth. Mayalso have deep bruising around the wound (dog held on for N seconds and bore down) or lacerations in both directions (dog held onand shook its head from side to side).Level 5. Multiple-bite incident with at least two Level 4 bites or multiple-attack incident with at least one Level 4 bite in eachLevel 6. Victim deadPlay between dogs at home escalate into fights
If your dog has threatened or bitten a person, please check all that apply

growls, lunges, and/or barks at people on walksGrowls, lunges, and/or barks at person in the homeBit a person handling your dogBit a person while on leashBit a person while dog was off leashBit person that was breaking up a dog fightLevel 1. Obnoxious or aggressive behavior but no skin-contact by teeth.Level 2. Skin-contact by teeth but no skin-puncture. However, may be skin nicks (less than one tenth of an inch deep) and slightbleeding caused by forward or lateral movement of teeth against skin, but no vertical puncturesLevel 3. One to four punctures from a single bite with no puncture deeper than half the length of the dog’s canine teeth. Maybelacerations in a single direction, caused by victim pulling hand away, owner pulling dog away, or gravity (little dog jumps, bites anddrops to floor).Level 4. One to four punctures from a single bite with at least one puncture deeper than half the length of the dog’s canine teeth. Mayalso have deep bruising around the wound (dog held on for N seconds and bore down) or lacerations in both directions (dog held onand shook its head from side to side).Level 5. Multiple-bite incident with at least two Level 4 bites or multiple-attack incident with at least one Level 4 bite in each.
When you need to leave your dog (to go to work, school, other) Does your dog do any of the following. Please indicate all that apply
Displays the following distressed behaviours:

WhineSelf mutilateBark excessivelyHowlScratch and/or bite crateScratch and/or bite doors, windows, walls, exit areas or places that smell like youUrinatesDefecatesPacesDroolsOveExcessive pantingOverheats
If your dog displays less distressed/anxious behaviours when you leave your dog home with any of the choices below, please check all that apply

If another human is present who is not part of the family unitIf another dog is present
Urinating and defecating behaviours, please indicate all that apply

Urinates when it meets (new) dogsDefecates On own bed and/or crateSeems to have trouble urinatingUrinates when greeting people, especially new peopleUrinates when excitedUrinates or defecates on carpetsUrinates on your bed or family member's bedDrinks excessive amounts of waterUrinates around house, does not void bladderDefecates on your bed or family member's bedDefecates or urinates mainly outside, occasionally insideUrinates or defecates inside if weather is bad (rain, snow, cold, too hot)
Waiver

I understand that dog training may involve risks to myself, members of my family, or my dog. I assume all risks associated with participating in private or group training sessions and will not hold ZENFULdog Training and its instructors/coaches, Kendra MacKinnon, responsible in the event of injury to myself, family members or my dogs. Trainer will make every reasonable effort to help client achieve training goals (we do not offer behaviour modification) but makes no guarantee of Dog’s performance or behavior as a result of providing professional animal training. I agree to comply with management and safety equipment. I also agree to assume all responsibility for any damage done to property, persons, or other dogs done by me or my dogs

I understand that all dogs participating in training sessions with ZENFULdog Training must be free of any infectious disease and parasites and must be current on all appropriate vaccinations; core vaccines plus bordetella.

I hereby agree and covenant myself, my heirs, executors, administrators, and anyone else who may claim on my behalf to waive, release, and discharge ZENFULdog Training and its instructors/coaches, Kendra MacKinnon, from any and all claims arising out of or in connection with or in any way related to the training session(s
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